Potential of Inflammatory Protein Signatures for Enhanced Selection of People for Lung Cancer Screening

Simple Summary Selection of appropriate high-risk smokers is one of the major challenges for implementing low-dose computed tomography screening for lung cancer. Many lung cancer risk prediction models have been proposed to supplement lung cancer screening. This study evaluated the potential of inflammatory protein markers to enhance lung cancer risk stratification beyond lung cancer risk models. The addition of inflammatory protein markers to existing lung cancer risk models improved risk prediction. The inflammatory protein markers may enhance current risk stratification and may be useful to identify high-risk populations for lung cancer screening. Randomized trials have demonstrated a substantial reduction in lung cancer (LC) mortality by screening heavy smokers with low-dose computed tomography (LDCT). The aim of this study was to assess if and to what extent blood-based inflammatory protein biomarkers might enhance selection of those at highest risk for LC screening. Ever smoking participants were chosen from 9940 participants, aged 50-75 years, who were followed up with respect to LC incidence for 17 years in a prospective population-based cohort study conducted in Saarland, Germany. Using proximity extension assay, 92 inflammation protein biomarkers were measured in baseline plasma samples of ever smoking participants, including 172 incident LC cases and 285 randomly selected participants free of LC. Smoothly clipped absolute deviation (SCAD) penalized regression with 0.632+ bootstrap for correction of overoptimism was applied to derive an inflammation protein biomarker score (INS) and a combined INS-pack-years score in a training set, and algorithms were further evaluated in an independent validation set. Furthermore, the performances of nine LC risk prediction models individually and in combination with inflammatory plasma protein biomarkers for predicting LC incidence were comparatively evaluated. The combined INS-pack-years score predicted LC incidence with area under the curves (AUCs) of 0.811 and 0.782 in the training and the validation sets, respectively. The addition of inflammatory plasma protein biomarkers to established nine LC risk models increased the AUCs up to 0.121 and 0.070 among ever smoking participants from training and validation sets, respectively. Our results suggest that inflammatory protein biomarkers may have potential to improve the selection of people for LC screening and thereby enhance screening efficiency.

Automated summary

This study assessed the potential of inflammatory protein biomarkers to enhance lung cancer risk stratification. The addition of these biomarkers to existing lung cancer risk models improved prediction accuracy. Inflammatory protein biomarkers may be useful for identifying high-risk populations for lung cancer screening.